The subject application relates to portable imaging systems, such as mobile fluoroscopic systems also generally known as portable C-Arms, which may be utilizing e.g., in an operation room. In particular, new and improved portable imaging systems are disclosed which provide for both hybrid flat panel x-ray imaging and computerized tomography (CT) imaging. The disclosed systems and methods have significant implications and applicability with respect to the fields of surgical imaging as interventional radiology.
Imaging plays a big role today in many surgical theaters including but not limited to neurosurgical spine and brain, orthopedic knee and hip, urological prostate and kidney, trauma (ER), etc. To date these surgeries have relied upon 2D X-ray or ultrasound imaging during surgery, and 3D CT and/or MRI both pre and post surgery. This is due primarily to the fact that it has been difficult to put a conventional CT or MRI into an operating room (OR). Conventional CT and MRI are both very large, require the patient to be moved into a bore, and have physical properties such as radiation and strong magnetic fields that cause concerns and compromise. However in the last 10 years we have seen the advancement of portable CT scanners, which can be manipulated in ORs. But even though these scanners have proven as breakthrough technology, they have not replaced the utility of 2D X-ray during major portions of the surgery where temporal resolution is required such as during the active insertion of an object. 2D fluoroscopy gives excellent temporal resolution under foot control of the surgeon. 2D images also are much lower in total radiation dose, which is good for both the patient and the surgical staff. But there are key times in the surgery where a 3D high quality CT image is both required and appreciated. In spine surgery this 3D image is used to confirm the angle of pedicle screw insertion and also to confirm correct placement after insertion of hardware.
Thus it would be optimal for surgeons to have OR access to both a 2D X-ray C-Arm and a high quality CT scanner. Existing portable CT scanners by Samsung/Neurologica and Mobius/Brainlab, however, do not have 2D C-Arm capability and thus make the surgical field very crowded and awkward to bring in another machine. The O-Arm system by Medtronic does have 2D and 3D capability but the CT quality is via a pseudo flat panel CT which is poor contrast resolution, small field of view, and bountiful with artifacts such as streaks. The O-arm 2D x-ray system also lacks the freedom of image angles and produces poorer image quality than conventional C-arms. Finally, while several C-arm manufacturers have enabled their C-arms to rotate and produce a CT-like image (such as the Siemens Orbic 3D) these systems suffer from the same image quality issues of the O-arm.
Thus, what is missing from the marketplace and what surgeons really desire one machine that can both act as a 2D X-ray C-arm and a high quality CT. Ideally such a machine maintain the special freedom of the C-arm, have high quality contrast resolution CT for a small longitudinal scan length, and have the ability to register with the surgical table for repeat scans later in the surgery that must be taken from the same position. Thus, there exists a need for improved portable hybrid imaging systems, which are capable of providing both CT and x-ray imaging with high quality while maintaining the maneuverability and ease of use of a traditional C-Arm. These and other needs are addressed by the systems disclosed herein.